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Evaluation and Treatment of the Ejaculatory Disorders

  • Michael A. Perelman
  • Chris G. McMahon
  • James H. Barada
Chapter

Abstract

Ejaculation, representing the physiologic means of semen and sperm delivery for reproduction has, until recently, received relatively little attention in the area of male sexual health. Yet, ejaculatory dysfunction, or male orgasmic disorder (MOD), is one of the most common male sexual disorders. The spectrum of MOD extends from premature ejaculation through various manifestations of diminished ejaculation: varying delays in ejaculatory latency to a complete inability to ejaculate, anejaculation, retrograde ejaculation, as well as reductions in volume, force, and sensation of ejaculation. This chapter uses a variety of conventional names describing male orgasmic or ejaculatory disorders. Although all investigators agree on what is being named, they do not necessarily agree on the names themselves.

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References

  1. 1.
    Kaplan H: The Evaluation of Sexual Disorders: Psychologic and Medical Aspects. New York: Brunner/Mazel; 1995.Google Scholar
  2. 2.
    Perelman M: Regarding ejaculation: delayed and otherwise [letter]. J Androl 2003, 24: number 4; July/August.Google Scholar
  3. 3.
    Masters WH, Johnson VE: Human Sexual Response. Boston: Little, Brown and Co.; 1966.Google Scholar
  4. 4.
    Shafik A: The mechanisms of ejaculation: the glans-vasal and urethromuscular reflexes. Arch Androl 1998, 41: 71–78.PubMedCrossRefGoogle Scholar
  5. 5.
    Karen LM, Barfield RJ: Differential rates of exhaustion and recovery of several parameters of male rat sexual behavior. J Comp Physiol Psychol 1975, 88: 693–705.PubMedCrossRefGoogle Scholar
  6. 6.
    Gil-Vernet JM, Jr, Alvarex-Vijande R, Gil-Vernet JM: Ejaculation in men: a dynamic endorectal ultrasonographical study. Br J Urol 1994, 73: 442–448.PubMedCrossRefGoogle Scholar
  7. 7.
    Mann T: Male Reproductive Function and Semen: Themes and Trends in Physiology, Biochemistry, and Investigative Biology. Berlin: Springer-Verlag; 1981: 171–193.CrossRefGoogle Scholar
  8. 8.
    Clark RV, Sherins RJ: Use of semen analysis in the evaluation of the infertile couple. In Male Reproductive Dysfunction: Diagnosis and Management of Hypogonadism, Infertility, and Impotence (Basic and Clinical Endocrinology Series, vol 7). Edited by Santen RJ, Swerdloff RS. New York: Marcel Dekker; 1986.Google Scholar
  9. 9.
    Ahlenius S, et al.: Behavioral Pharmacology of 5-HT. Hillsdale: 1989.Google Scholar
  10. 10.
    Haensel SM, Mos J, Olivier B, Slob AK: Sex behavior of male and female Wistar rats affected by the serotonin agonist 8-OH-DPAT. Pharmacol Biochem Behav 1991, 40: 221–228.PubMedCrossRefGoogle Scholar
  11. 11.
    Mos J, Mollet I, Tolboom JT, et al.: A comparison of the effects of different serotonin reuptake blockers on sexual behavior of the male rat. Eur Neuropsychopharmacol 1999, 9: 123–135.PubMedCrossRefGoogle Scholar
  12. 12.
    Waldinger MD: The neurobiologic approach to early ejaculation. J Urol 2002, 168: 2359.Google Scholar
  13. 13.
    Shenassa B, Hellstrom WJG: Understanding ejaculatory disorders. Contemporary Urology 2001, April: 51–59.Google Scholar
  14. 14.
    Perelman M: Sex coaching for physicians: combination treatment for patient and partner. Int J Impot Res 2003, 15 (suppl 5): s67 - s74.PubMedCrossRefGoogle Scholar
  15. 15.
    Suzuki H, Tominaga T, Kumagai H, Saruta T: Effects of first-line antihypertensive agents on sexual function and sex hormones. J Hypertens 1988, suppl 6.Google Scholar
  16. 16.
    Lallemand F, Salhi Y, Linard F, et al.: Sexual dysfunction in 156 ambulatory HIV-infected men receiving highly active antiretroviral therapy combinations with and without protease inhibitors. J AIDS 2002, 30: 187–190.Google Scholar
  17. 17.
    Seftel AD, Althof SE: Rapid ejaculation. Curr Urol Rep 2000, 1: 302–306.PubMedCrossRefGoogle Scholar
  18. 18.
    World Health Organization: Second International Consultation on Erectile and Sexual Dysfunction.Google Scholar
  19. 19.
    Perelman M: Premature ejaculation. In Principles and Practices of Sex Therapy. Edited by Lieblum S, Pervin L. New York: Guilford Press; 1980.Google Scholar
  20. 20.
    Waldinger MD, Hengeveld MW, Zwinderman AH, et al.: Effect of SSRI antidepressants on ejaculation: a double-blind, randomized, placebo-controlled study with fluoxetine, fluvoxamine, paroxetine, and sertraline. J Clin Psychopharmacol 1998, 18: 274.PubMedCrossRefGoogle Scholar
  21. 21.
    McMahon CG: Long term results of treatment of premature ejaculation with selective serotonin re-uptake inhibitors. Intl Impot Res 2002, 14: S19.CrossRefGoogle Scholar
  22. 22.
    Carson CC, Glasser DB, Laumann EO, et al.: Prevalence and correlates of premature ejaculation among men aged 40 years and older: a United States population-based study. J Urol 2003, 169:abstract 1649.Google Scholar
  23. 23.
    Simons J, Carey MP: Prevalence of sexual dysfunctions: results from a decade of research. Arch Sex Res 2001, 30.Google Scholar
  24. 24.
    Spector, KR, Boyle M: The prevalence and perceived aetiology of male sexual problems in a nonclinical sample. Br J Med Psychol 1986, 59: 351.PubMedCrossRefGoogle Scholar
  25. 25.
    Metz ME, Pryor JL: Premature ejaculation: a psychophysiological approach for assessment and management. J Sex Marital Ther 1997, 23: 3.PubMedCrossRefGoogle Scholar
  26. 25a.
    McCarthy B: Relapse prevention strategies and technique with erectile dysfunction. J Sex Marital Ther 2001, 27: 1–8.PubMedCrossRefGoogle Scholar
  27. 26.
    Lauman EO, Michael RT, Gagnon JH: A political history of the national sex survey of adults. Fam Plann Perspect 1994, 26: 34–38.CrossRefGoogle Scholar
  28. 27.
    Scaletta LL, Hull EM: Systemic or intracranial apomorphine increases copulation in long-term castrated male rats. Pharmacol Biochem Behav 1990, 37: 471–475.PubMedCrossRefGoogle Scholar
  29. 28.
    Lorrain DS, Matuszewich L, Howard RV, et al.: Nitric oxide promotes medial preoptic dopamine release during male rat copulation. Neuroreport 1996, 8: 31–34PubMedCrossRefGoogle Scholar
  30. 29.
    Xin ZC, Chung WS, Choi YD, et al.: Penile sensitivity in patients with primary premature ejaculation. J Urol 1996, 156: 979–981.PubMedCrossRefGoogle Scholar
  31. 30.
    Paick JS, Jeong H, Park MS: Penile sensitivity in men with early ejaculation. Int J Impot Res 1998, 10: 247.PubMedCrossRefGoogle Scholar
  32. 31.
    Bleustein CB, Eckholdt H, Arezzo JC, Melman A: Effects of circumcision on male penile sensitivity [abstract]. J Urol 2003, 169: 1260.Google Scholar
  33. 32.
    McCarthy B: Integrating Viagra into cognitive-behavioral couple’s sex therapy. J Sex Educ Ther 1998, 23: 302.Google Scholar
  34. 33.
    McCullough A: Ejaculation Disorders. Edited by Mulcahy J. Totowa, NJ: Humana Press; 2001.Google Scholar
  35. 34.
    McMahon CG, Tourna K: Treatment of early ejaculation with paroxetine hydrochloride as needed: 2 single-blind placebo controlled crossover studies. J Urol 1999, 161: 1826.PubMedCrossRefGoogle Scholar
  36. 35.
    Waldinger MD: The neurobiologic approach to premature ejaculation. J Urol 2002, 168: 2359.Google Scholar
  37. 36.
    Machtens S, Ckert S, Stief CG, et al.: Effects of various nitric oxide-donating drugs on adrenergic tension of human seminal vesicles in vitro. Urology 2003, 61: 479–483.PubMedCrossRefGoogle Scholar
  38. 37.
    Abdel-Hamid IA, El Naggar EA, El Gilany AH: Assessment of as needed us of pharmacotherapy and the pause-squeeze technique in early ejaculation. Int J Impot Res 2001, 13: 41.PubMedCrossRefGoogle Scholar
  39. 38.
    McMahon CG: Long term results of treatment of premature ejaculation with selective serotonin reuptake inhibitors. Int J Impot Res 2002, 14 (suppl 3): S19.CrossRefGoogle Scholar
  40. 39.
    Salonia A, Maga T, Colombo R, et al.: A prospective study comparing paroxetine alone versus paroxetine plus sildenafil in patients with early ejaculation. J Urol 2002, 168: 2486.Google Scholar
  41. 40.
    Rowland DL, Tai WL, Slob AK: An exploration of emotional response to erotic stimulation in men with early ejaculation: effects of treatment with clomipramine. Arch Sex Behav 2003, 32: 145.PubMedCrossRefGoogle Scholar
  42. 41.
    Bancroft J: Central inhibition of sexual response in the male: a theoretical perspective. Neurosci Behav Rev 1999, 23: 763.CrossRefGoogle Scholar
  43. 42.
    Apfelbaum B: Retarded ejaculation; a much-misunderstood syndrome. In Principles and Practice of Sex Therapy: Update for the 1990s. Edited by Lieblum SR, Rosen RC. New York: Guilford Press; 1989.Google Scholar
  44. 43.
    Perelman M: Sildenafil, sex therapy, and retarded ejaculation. J Sex Ed and Ther 2001, 26: 13–21.Google Scholar
  45. 44.
    Blanker MH, Bosch JL, Broeneveld FP, et al.: Erectile and ejaculatory dysfunction in a community-based sample of men 50 to 78 years old: prevalence, concern, and relation to sexual activity. Urology 2001, 57: 763–768.PubMedCrossRefGoogle Scholar
  46. 45.
    Rosen R, Altwein J, Boyle P, et al.: Lower urinary tract symptoms and male sexual dysfunction: the Multinational Survey of the Aging Male (MSAM-7). Eur Urol 2003, 44: 637–649.PubMedCrossRefGoogle Scholar
  47. 46.
    Heiman JR, Meston CM: Empirically validated treatment for sexual dysfunction. In Annual Review of Sex Research. Edited by Rosen R, Davis C, Ruppel H. Mount Vernon, IA: The Society for the Scientific Study of Sexuality; 1998.Google Scholar
  48. 47.
    Nurmberg HG: Treatment of antidepressant-associated sexual dysfunction with sildenafil: a randomized controlled trial. JAMA 2003, 1: 56.Google Scholar
  49. 48.
    Nurmberg H, Lauriello J, Hensley PL, et al.: Sildenafil for women patients with antidepressant-induced sexual dysfunction. Psychiatric Survey 1999, 60: 33.Google Scholar
  50. 49.
    Frankel SJ, Donovan JL, Peters TI, et al.: Sexual dysfunction in men with lower urinary tract symptoms. J Clin Epidemiol 1998, 51: 677–685.PubMedCrossRefGoogle Scholar
  51. 50.
    Arai Y, Aoki Y, Okubo K, et al.: Impact of interventional therapy for benign pro-static hyperplasia on quality of life and sexual function: a prospective study. J Urol 2000, 164: 1206–1211.PubMedCrossRefGoogle Scholar
  52. 51.
    Abrahams JI, Solish GI, Boorjian P, et al.: The surgical correction of retrograde ejaculation. J Urol 1975, 114: 888.PubMedGoogle Scholar
  53. 52.
    Kedia K, Markland C: The effect of pharmacological agents on ejaculation. J Urol 1975, 114: 569.PubMedGoogle Scholar
  54. 53.
    Nijman JM, Jager S, Boer PW, et al.: The treatment of ejaculation disorders after retroperitoneal lymph node dissection. Cancer 1982, 50: 2967.Google Scholar
  55. 54.
    Bors E, Comarr AE: Neurological disturbances of sexual function with special reference to 529 patients with spinal cord injury. Urol Sury 1960, 10: 191.Google Scholar
  56. 55.
    Comarr AE: Sexual function among patients with spinal cord injury. Urol Int 1970, 24: 134.CrossRefGoogle Scholar
  57. 56.
    Brindley G: Sexual and reproductive problems of paraplegic men. Oxf Rev Reprod Biol 1986, 8: 214.PubMedGoogle Scholar
  58. 57.
    Ohl DA, Bennett CJ, McCabe M, et al.: Predictors of success in electroejaculation of spinal cord injured men. J Urol 1989, 142: 1483.PubMedGoogle Scholar
  59. 58.
    Brindley GS: The fertility of men with spinal injuries. Papaplegia 1984, 22: 337.CrossRefGoogle Scholar
  60. 59.
    Steinberger RE, Ohl DA, Bennet CJ, et al.: Nifedipine pretreatment for autonomic dysreflexia during electroejaculation. Urology 1990, 36: 228.PubMedCrossRefGoogle Scholar
  61. 60.
    Hovatta O, von Smitten K: Sperm aspiration from vas deferens and in-vitro fertilization in cases of non-treatable anejaculation. Hum Reprod 1993, 8: 1689.Google Scholar
  62. 61.
    Perelman M: The impact of the new sexual pharmaceuticals on sex therapy. Current Psychiatry Reports 2001, 3: 195–201.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2004

Authors and Affiliations

  • Michael A. Perelman
  • Chris G. McMahon
  • James H. Barada

There are no affiliations available

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